| NPI | 1073399929 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA GRAHAM Owner 928-210-3767 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 302F00000X Exclusive Provider Organization |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2024-03-06 |